Diabetes is on the rise. A 2015 CDE report estimates that around 3.85 million South Africans struggle with the condition. The report goes on to provide even more insight into these numbers:

“To fully appreciate the current statistics on the prevalence of diabetes in South Africa, one needs to look back. In 2010, the prevalence of type 2 diabetes in South Africa was estimated at 4.5%… Recent data from the International Diabetes Federation (IDF) estimates that 7 % of South Africans between the ages of 21 and 79 years have diabetes.”

That means the incidence of diabetes diagnosis increased by 2.5% in just 5 years.

This begs an important question:

Why has the rate of diabetes diagnoses increased so much? What’s making all these people so sick?

Most of us have heard that people with diabetes have brought it on themselves, by indulging in too much rich, sugary, food. It’s scientific fact, right?

Actually, no.

Diabetes diagnoses in context

There are many reasons for this increase in diabetes diagnoses. The first thing to note is that the number of people over the age of 60 has increased since 1950.  This explains, at least in part, why we are seeing an increase in age-related illness.

Diabetes diagnosis criteria change

Another factor impacting the rate of diabetes diagnosis is that the criteria by which someone with diabetic symptoms qualifies as ill have changed since these measurements began. In 1999, the World health Organisation  changed the criteria for diabetes diagnosis. The feasting blood sugar level required to confirm a diagnosis of diabetes was changed from 6.8mmol/l to 6.1mmol/l.  (More here.)

The diabetes diagnosis trend – a short summary

While there is an increase in the number of people with diabetes, there is also an increase in the number of people. The population is growing, and people are living longer than ever before. Most diabetics are over 60, yet in the 50s far fewer people even lived beyond 60.

There is also an increase in the percentage of people with diabetes. This can be explained by three key factors:

  • The criteria for diagnosing diabetes have expanded to include a wider group of people;
  • The diagnostic tools have become more sophisticated and can thus detect cases that may previously have been overlooked; and,
  • As we mentioned above, people are living longer than before. A longer lifespan brings with it a higher incidence of age-related illnesses, including diabetes.

What causes diabetes?

The more research is done on diabetes, the more it becomes clear that there’s no single cause of the disease. There are many contributing factors, and in most cases these all work together to result in compromised health. It is also increasingly clear that the research has a long way to go. We just don’t know everything there is to know about diabetes.

Here’s what we do know:

The Top Six Causes of Type 2 Diabetes

  1. Genetics
  2. Hormones
  3. Stress
  4. Lifestyle
  5. Obesity
  6. Insulin resistance

It’s in the genes

AN NIH study explains why it’s important to identify the link between diabetes and the genes that could be responsible for it:

Identification of the genetic components of type 2 diabetes is one of the most important areas of diabetes research because elucidation of the diabetes genes (alleles) will influence all efforts toward a mechanistic understanding of the disease, its complications, and its treatment, cure, and prevention.

Raging hormones?

Insulin is a hormone, so it stands to reason that hormonal fluctuations contribute in some way to diabetes and both its development and prognosis. Because hormones can affect the way cells process fuels of all kinds, including sugars and fats, changes in these hormones affect cells’ abilities to do their job.

Hormone fluctuations during pregnancy can cause gestational diabetes. ‘Hormones produced by the placenta contribute to insulin resistance, which occurs in all women during late pregnancy. Most pregnant women can produce enough insulin to overcome insulin resistance, but some cannot. Gestational diabetes occurs when the pancreas can’t make enough insulin,’ per the NIH.

Stressed out?

Stress has a significant influence on hormonal balance. The NIH reports that ‘insulin may decrease during stress. This…  can contribute to stress-induced hyperglycaemia.’ The report also points out that ‘Severe stress may be a risk factor for diabetes. Children aged five to nine years with stress were significantly more likely to be diabetic.’

Lifestyle choices

There appears to be something of a common thread in the lifestyle choices of diabetics prior to their diagnosis. Many enjoy a diet rich in fatty foods, exercise rarely, and suffer from high levels of stress. (See above.)

What we found particularly relevant here is that a stressful lifestyle is its own worst enemy.

Stress often results from being too busy, and even if busy-ness isn’t the primary driver of the stress response, it is usually a contributing factor. Being too busy often means not having the time to exercise. It also means there’s little time for thoughtful food shopping. Foods are chosen for their convenience and comfort factors, rather than their organic health status. There is usually little time available for food preparation, so quick, easy meals are preferred.

Insulin Resistance

Over time, it can become difficult for the insulin to gain entry to the fat cells (adipocytes). When this happens, more insulin is needed to do the same job. The result is an increase in insulin in the blood. This phase is known as insulin resistance.

During insulin resistance, which can last for as long as ten years or even more, the pancreas has to produce more insulin than they were designed to. Essentially, this means the pancreas produces double or even triple their original capacity. Eventually, the pancreas burns out and becomes unable to produce insulin.

Type 2 diabetes results the pancreas no longer releases enough insulin to process the sugar (glucose) in the blood. This leads to decline in glucose transport to cells, meaning that cells can’t derive the energy they need from the food (which should be fuel) that the body consumes. (More here.)

Obesity

A combined report from both the Nurses’ Health Study and the Health Professionals Follow-up Study found that

‘… men and women whose body mass indices were in the overweight range (25.0 kg/m2–29.9 kg/m2) were 4.6 and 3.5 times more likely to develop diabetes, respectively, compared with those whose body mass indices were below 25 kg/m2.’

By consuming more calories than our bodies need, and exercising less than we should in order to balance that consumption, we put pressure on our endocrine systems to cope. This lifestyle both adds to the glucose load in the bloodstream, and reduces the cell’s response to insulin. In short, fat blocks insulin receptors.

As we saw earlier, stress also contributes to the body’s ability to use insulin efficiently. But it doesn’t stop there. Chronic stress can cause the body to manufacture more stress-regulating hormones to cope with it, at the expense of other hormones … including insulin: (More here.)

Causes of Diabetes: A Summary

Unfortunately, there’s no short-and-sweet solution to the causes of diabetes. There are many contributing factors, and the science has a long way to go to reach a clear conclusion. Moderation is key. If you have a family history of diabetes, for instance, it’s smart to stay fit.

Most important of all, find a doctor you can trust, and develop a frank, honest relationship with him or her. That way, you’ll both be ready to handle whatever comes up, and make the lifestyle changes that can help you avoid the risk of getting sick, or make it easier to manage your illness if you do develop diabetes.

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